Hashimoto's thyroiditis: celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records

Abstract

Hashimoto's thyroiditis is now considered the most prevalent autoimmune disease, as well as the most common endocrine disorder. It was initially described in 1912, but only rarely reported until the early 1950s. To celebrate this centennial, we reviewed the surgical pathology archives of the Johns Hopkins hospital for cases of Hashimoto's thyroiditis, spanning the period from May 1889 to October 2012. Approximately 15,000 thyroidectomies were performed at this hospital over 124 years. The first surgical case was reported in 1942, 30 years after the original description. Then, 867 cases of Hashimoto's thyroiditis were seen from 1942 to 2012, representing 6% of all thyroidectomies. Hashimoto's thyroiditis was the sole pathological finding in 462 cases; it accompanied other thyroid pathologies in the remaining 405 cases. The most commonly associated pathology was papillary thyroid cancer, an association that increased significantly during the last two decades. The most common indication for thyroidectomy was a thyroid nodule that was cytologically suspicious for malignancy. Hashimoto's thyroiditis remains a widespread, intriguing, and multifaceted disease of unknown etiology one century after its description. Advances in the understanding of its pathogenesis and preoperative diagnosis will improve recognition and treatment of this disorder, and may one day lead to its prevention.

FIG. 1.

Annual number of Hashimoto's thyroiditis cases (dotted line) among the thyroidectomies (dashed line) performed at the Johns Hopkins Hospital between May 1889 and October 2012. The numbers of all surgical specimens processed by the Department of Pathology (solid line) is also shown. The arrow indicates year 1942, the time when the term “Hashimoto thyroiditis” was first used in a pathology report at this hospital.

FIG. 2.

Prevalence of the coexistence of Hashimoto's thyroiditis (HT) with papillary thyroid cancer (PTC), Hürthle cell cancer (HCC), medullary thyroid cancer (MTC), follicular adenoma (FA), follicular thyroid cancer (FTC), and nodular goiter (NG). p-Values compare by chi-squared the coexistence of HT and PTC to the coexistence with other thyroid pathologies.

FIG. 3.

Annual numbers of HT cases associated with PTC (dotted line), HT cases associated with multinodular goiter (dashed line), and isolated cases of HT (solid line).

FIG. 4.

Annual numbers of isolated PTC (dashed line), PTC associated with HT (dotted line), and PTC associated with chronic nonspecific lymphocytic thyroiditis (solid line).

FIG. 5.

Histopathological features of Hashimoto's thyroiditis. Left panels: Microphotographs originally presented by Dr. Hashimoto in 1912. Right panels: Corresponding hematoxylin and eosin (H&E) histopathological features. (Legends for the left panels are our translation of the original legends.) (A) Low-power view showing pronounced lymphoid follicles within the thyroid parenchyma. a, lymphoid follicles with germinal center; b, diffusely hypertrophic interstitium; c, atrophic thyroid follicles containing scarce colloid. (B) A 20× magnification showing similar features as those described in (A). (C) Interstitial changes. a, lymphoid follicle; b, blood vessel; c, nest of lymphocytes; d, abnormal thyroid follicles showing atrophy, ill-defined borders, and scarce colloid; e, nuclear division. (D) A 64× magnification illustrating features similar to (C). The inset (252×) depicts a cell undergoing nuclear division. (E) Thyroid follicle changes. a, thyrocytes are bold, stratified in some regions, and with undefined boundaries; b, the colloidal space contains infiltrating leukocytes; c, leukocytes migrating through the follicular wall; d, mononuclear cells in the interstitium. (F) A 160× magnification showing the metaplastic transformation of the thyroid epithelium we now refer to as Hürthle cells, as well as the penetration of lymphocytes into the thyroid cell, named emperipolesis. (G) Marked proliferation of the interstitial connective tissue. a, hypertrophic connective tissue; b, small atrophic thyroid follicles with near-absent colloid; c, pronounced mononuclear (lymphocytic) infiltration; d, blood vessel. (H) A 64× magnification showing abundant fibrosis, small remaining thyroid follicles surrounded by lymphocytes. (I) Notable changes. a, lymphoid follicle with germinal center; b, thyroid follicles with scanty colloid and dense appearance; c, multinucleated giant cell; d, interstitial proliferation with mononuclear infiltration. (J) A 64× magnification summarizing features illustrated in previous panels, as well as a rare multinucleated giant cell (inset).